Friday, July 30, 2010

I believe that each time I get on a plane that my luggage will be delayed, lost or destroyed (or all of the above).

I believe that a blizzard, freezing rain, hurricane winds, a power outage, a malfunctioning video screen, ice on the plane, snow on the tarmac, an abandoned suitcase, an ash cloud, a frozen propeller, damage due to impact with a pick-up truck, a non-starting engine, or a bird will hamper my flight plans.

I believe all of this because in the last 3 years all of those events have occurred. Yep. Every single one of them. Today one of my old favorites which I haven't experienced in a long time thwarted my itinerary: marine fog. Oh marine fog, why do you choose to not burn off the mornings I want in, and roll in early on the days that I want out?

So we landed in another town and had to take a bus the rest of the way. I wasn't too fussed about it all since I had ample battery power on all my distraction devices and an orange. But Holy Butter-Icing Batman was the heavily tattooed gent in the tracksuit ever hopping up and down about a cake that he had carried on board.

He actually was swearing at the agent on the tarmac about the fact that there was no refrigerator on the bus. Apparently he was going to have a very effing angry client. Like it was her fault.

[Insert chain smoking and pacing here.]

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Anyway, the bonus was running into a long-lost housemate, B.B, from 10 years ago at the Vancouver airport, then discovering that she and her husband (boyfriend when I last saw them) were coming here as well for a fishing holiday. They also had an 8 week bambino in tow. She was very cute and well behaved, just how I like bambinos. The last time I saw B.B. I was in nursing school and WOW have I changed since then. It was a pretty dark time in my life to be honest. I hope that she was able to see how much of a 180 degree spin things have taken since then.

When they asked what I was up to I just said, "I am in medical school in Ireland, just home working for the summer". Which is the most direct answer I have ever given about my state of affairs--I usually dance around things by saying, "yeah, I am working for the summer...no I am not living in BC anymore...no I am living in Ireland....yeah I am there living not visiting...oh, yes I am a student....er well actually I am in medical school....yeah...it's pretty good..." etc.

Then I felt weird about how I said what I was doing. Did it sound showy? Or braggy? That is why I hate throwing out the MD school thing like that. But then I sound cagey and evasive. Falsely humble or something.

Ah well, I am working on tactful directness.

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It was a wonderful few days with K.B. We just relaxed and cooked, drank wine and talked, walked. A great break in the middle of my contract. I am feeling good heading back to work tomorrow. My soul has been watered. It is exactly 4 weeks from today until I am in Ireland again!

My excitement is certainly growing. Mostly because I cannot WAIT to see Tobie who I've had in my clutches for only a week since May 17th. It has been really tough being apart for most of the summer. He's off to Ireland in 4 days, doing a course in Spain for a couple of weeks, and then setting up our "Nest" in Ireland for my arrival. I am also looking forward to seeing my good friends who are in Ireland and various North American locations (yes you too George!) It's strange being so tightly compacted in a ball of stress with a core group of people and then being tossed apart for the summer.

Off to the store to get stocked up for the next round of 'Living in the Hospital, 2010'.

Tuesday, July 27, 2010

I performed some shift-swapping wizardry this week to have 5 days off in a row and had originally planned to visit Haida Gwaii. One of the nurses has a guest house there and offered it to me for free for the week. But the long ferry ride and logistics of more time alone in a beautiful new place just wasn't as appealing as when I first dreamed up the idea. Frankly, I have spent a lot of time alone in amazing landscapes and I'm at a place where I like sharing those experiences with people I love now, be it friend or partner. Tobie has never been to the West Coast (I know, how is it possible??) so I decided to save that gem of a location for us to discover together at a later date.

Instead I drained the last of my aeroplan miles and booked a flight to Vancouver to visit my best friend, K.B. She and I have been connected in this world since the time when we both had all of our baby teeth. We were those friends who wore matching outfits and went to summer camp together. She was the one I first snuck booze with from my parent's cupboard, the one whose Barbie mansion I envied, and the one whose trampoline I spent most of my summer on every year.

As 'grown ups' she and her husband were among the friends who took me in during a difficult breakup, and let me use their spare room as a home base during a year of travel nursing gigs. She also did half of my paper work for medical school applications when I was away in India.

I studied all summer for the MCAT on her deck and trained with her for my Himalayan adventure.

It was K.B who knew my MCAT score before I did. I had a connection in Singapore where I was able to check my email and she had sent me the note titled "CONGRATS!"

She is a big part of the reason I am in medical school today. If they had not been so generous with their home I would have never had the chance to study and prepare as much as I did for both the MCAT and application process. They are two people in a large cast of characters who have brought me to this place, from my Revelstoke family to my genetically linked family in AB to my near-and-dears scattered all over this crazy world.

I have been so lucky to have such wonderful support on this wild dream-chasing adventure. As I sit here on her deck once again, one year of medical school behind me, I am brought back to the summers of 2008 and 2009. Often during those muggy days I felt completely lost, with a future that seemed so unbelievably uncertain. They listened to me cry and witnessed a lot of teeth gnashing, but there was also a lot of laughter and delicious meals, days shopping for things like the perfect salt for a spice rub, and Saturday morning latté conversations.

I'm so happy that I decided to come here for a tiny holiday, even if I just sit on this deck for the next 3 days. The disequilibrium I used to feel in this chair is gone.

Here's to friends who have been along for the ride, and being back in my happy place!

Sunday, July 25, 2010

I have been staring at this shade of grey quite a bit lately. When a patient's care shifts from 'do everything possible to keep them alive' to 'do not resuscitate' things are pretty black and white. Or so it seems. But where is the line between 'do not resuscitate' and 'discontinue treatment'?

I know that I am not wading into anything new here when it comes to the ocean of medical ethics, but I've had two cases in the past two weeks that have caused me to look at my own practice as a nurse, and the decisions I will be faced with as a physician. And I can't help but wonder if my smugness and confidence will disappear when I am the one who needs to make the call. Or will it be easier because there will be a greater distance between me and direct patient care?

Look, I know it is easy to judge orders as a nurse. We are wrapped in a protective covering of arms-length responsibility when it comes to patient care decisions. Now before people start hopping up and down I am not saying that nurses don't hold a great deal of responsibility, they do. It is just for a different aspect of the care. I have to check myself when I feel the inevitable eye-roll that comes with certain orders, or my frustrations with care plans that I don't agree with. But he bottom line is that the physician who guides the care plan is the one who is taking the risks. This I need to remind myself of, from time to time.

Yesterday I took care of someone who went from fidgeting with his bedclothes and asking to go home, to someone who was becoming less responsive and confused, to someone who was dead. And somewhere along that trajectory we all had to accept that we were not going to save him. I don't like the fact that at the beginning of my shift I was explaining to his sister that we were just doing some tests and rehydrating him, to at the end of my shift saying that we'd do everything we could to keep him comfortable.

I didn't like looking down at his purple, blue, and red arm where he'd been poked so many times already that day for blood work knowing that still more blood was going to be drawn from that site before the end of the night.

I didn't like that I didn't have time to give him a proper bath, put lotion on his feet.

I didn't like the fact that before his shit encrusted blue jeans hit the floor his children had already cleaned out the pockets for cash.

And I didn't like disagreeing with the doctors orders. Keep on the monitor. Repeat blood work. Push fluids. And yet I remind myself that it is not my medical license on the line, he was just doing his job to ensure that no one could fault his management, he reminded me that a "DNR was not an order not to treat". I get it, and to be honest, I went down that road last week already in a similar situation and I didn't feel like arguing anymore. He's actually a good physician who really takes the time to discuss the issues with family members, and he is not delusional when it comes to recognizing the point when medical science has gone the distance but simply petered out.

It's just that he gets to leave. And we are there at the bedside. Seeing the family members mesmerized by the lights of the monitor. We are the ones who have to look away from the blood pressure readings that are 59/30...53/31...50/28. We are the ones hanging the next bag of fluid that is certainly not going to drain out of the catheter. We are the ones putting the O2 sat machine on over and over again when the patient keeps pulling it off. We are the ones turning him back and forth to keep the unmoving blood from causing sores, listening to him moan in pain with any movement.

I envied the doctor last night when he finished his orders and walked out the automatic doors. I looked from the door, back to the monitor, and to the patient's sisters crying at the bedside. It was one thing to know that if he stopped breathing or his heart stopped we were not meant to intervene...but right up until that point were we improving his quality of life or just going through the medical motions?

Saturday, July 24, 2010

I must say that I was really touched by the response to my last post. Touched and intrigued. Appreciative as well.

Oh and I laughed too, which is always enjoyable.

So, the lessons that I have learned based on the last comments section;

-babies (and triathlons) can be overrated, and I'll still be able to do those things later if I really want to

-the first month of an EM residency can involve brewing alcohol, hiking and running

-other people think it is normal to have blog-friends (people you may or may not ever meet)

-people with no formal training in English (ertwro) who live in Columbia can send beautifully written comments, relate to this crazy journey, and give such stellar analogies to blogging, "it's like being naked on a deserted beach, shouting, "look! I'm body painted!', it's kind of nakedness". Love it.

-this IS a community, not just in my own mind

-SYRACUSE! =) There is a person in Syracuse. And she *also* has a partner who may or may not appreciate the gory stories from work. Tobie is actually very good at putting up with my rambles but there is something to say about being able to vent without having to explain what one is

-that maybe I should not be so worried about how it is all received and just go with it

-people who I read/respect think I am worth reading--truly the ultimate compliment

-Grumpy's children may kill him later when they read his blog as adults

-other nurse-to-doctors-to-be are struggling with the same questions and frustrations I went through (and am going through)

-apparently my name comes up in conversation (and old acquaintances follow my blog)! (Does everyone else assume that they are never interesting enough to come up in conversation?? hahahah)

-there are people in cyper space rooting for me--ok that is such a crazy and beautiful thing to wrap my head around...if there is anything to the power of prayer than *surely* there is something to the power of "rooting!" Sweet. Believe me, I appreciate it, and draw on that.

-people actually look forward to my next post!

I have to be honest, I have been mulling around many posts the last few days but was so enjoying the comments and emails that were rolling in that I didn't want to start stacking on top--just yet. Now my ego has gotten larger than it should, and I have probably done enough of a love-in, so I will resume regular ranting and whining.

And all this, just over two years from the inaugural post...what a strange long trip it's (already) been.

Tuesday, July 20, 2010

I don’t feel completely at home in Ireland, and I don’t feel completely at home in Canada right now.

It is a strange sensation of displacement. Having been on the move so much in Canada the last few years there is no one place that is home to me. There are people that represent ‘home’ but they are so scattered around North America that I’d be hard pressed to see even half of them on one of my journey’s back.

A line that rings in my head often is ‘strangers are exciting, their mystery never ends…but there is nothing like looking at your own history in the faces of your friends’*. It has been loud and clear these past few days. But that history represents a much different time in my life. So naturally I feel nostalgic for those times that make me laugh so hard I cry when I reminisce about them now.

At this point in time I feel out of sync. I am not on the baby train. Or the reno train. Or the triathalon train. Or the travelling adventure train. Am I wasting my 30's? The time when I could have had ample time and cash to undertake a large portion of my bucket list?

I feared that the damn grass of medical school was going to be less green once I crossed the lawn. When I was stoking a wooden fire in Revelstoke I was madly working toward getting into school, and now that I am here I sit and think about the countless meals AMG and I prepared together in her kitchen, or the hikes Kara and I went on in the Fraser Valley. I don't want the blessing of wayward tendencies to become a curse of 'forever roaming with a hungry heart'.

I see how it is easy to become one of those medical students, sequestered and estranged from the people who are currently on a ‘normal’ life trajectory (whatever that means but there are definitely some themes around me I can't ignore). Things seem right when I am writing though, I don't feel out of step or weird for not having a uterine ultrasound as my FB profile photo.

Suddenly life feels normal when I hear about OMDG bashing her head against the wall with a frustrating mentor, or Ninja bridging the divide between nursing and medicine, Beach Bum going through the Canadian IMG hoops, BINY suffering the frustrations of emergency medicine.

Is it exhibitionist for me to talk about something like this on my blog? I am not sure. I suppose I break one of the first rules of writing every time I publish a post.

Who are you writing for? Who is your audience?

Well for the most part I have no ever-lovin’ clue.

The questions are hard to answer because this blog has really changed in the past 2 years.

Initially I wrote for myself. It was just a long string of documents that would hopefully weave into a trail showing my journey from A to B; if I ever got to B. I had almost zero readers (other than very good friends like Nature Nerd, Gillatron, Simmers and a handful of randoms—BINY, Rogue, and Beach Bum).

As my blog trundled along it seemed to pick up readers along the way. I started thinking more about who might be reading my random babbles and attempted to put more effort into the content. It became more reader driven.

But the more my life scatters around Canada and Ireland, the more I feel like this blog is my anchor. It feels like it is for me again. My sanity. The blogs I read almost daily (Ninja, OMDG, Grumpy, Amanzi, etc) are like a strange motley crew of virtual friends who share sections of their lives, which I follow and can relate to. And somehow the number of people that read my blog continues to grow, which encourages me to write more. I am baffled that my (seemingly mundane) updates from the study front capture the interest of others (besides my immediate family and close circle of friends).

Maybe some of you reading there in the background will leave a little ditty in the comment box, no identifiers necessary, maybe just a snippet of your story. I’d love to have some idea who is out there. Syracuse? Oranjestad? Gardanne?

So I feel out of step with the world sometimes…I suppose I am not the only person who finds a sense of community and enjoyment out of the blue glow of a computer screen. I supposed I hesitatingly resign to that and the stereotypes that come to mind.

Starting to settle into my hospital provided housing. Been working like a dog (a happy dog but a dog nonetheless) for the past 13 days. Since my arrival I have been at the hospital every day, either leaving in the morning or showing up in the evening. Or both.

On my first morning I looked up from my tea and saw a bald eagle swooping out my window. Voila.

Can you spot the three bald eagles?

This place is certainly a step up from many hovels I've been assigned to in my adventures as a travelling nurse. Quirky, woody, borderline funky, and creaky. But a killer view and for two more days it's just me here (a rare treat in this game where cramming as many people as possible into staff housing is paramount).

Can't you just see John Travolta lounging in a white sequin onesie on that couch?

Something about this kitchen gives me the urge to prepare a jello salad. With tiny marshmallows.

Thursday, July 15, 2010

So for a long time I always thought that if I ever became a doctor I'd work in emergency medicine*. It was dynamic and interesting, there were sphincter tightening moments and breezy presentations. Another bonus was that quirky personalities seemed drawn to that type of medicine. Hello, ABB finally fits in somewhere in healthcare.

I know I am going through the usual blush that medical students undergo with each specialty that trots in front of them during medical school. Yes, I was in a real anesthetist kick for the past year, but with more of a critical care/ED/pain specialty intention than an OR intention.

In the past week I've spent some time in the OR, shadowing a general surgeon and an orthopod. And holy mother of scalpels--I am in love.

Things I love about the OR/surgery:

-it's clean, sterile in fact!
-at the end of a 12h shift you don't feel the need to scrub yourself with lye and chlorhexidine in an attempt to get rid of the dirt that just wont wash off...
-patients are cooperative and unable to yell profanities at you/spit at you/bite you
-it is totally hands on, hello procedure-ville
-you get to look at imagining, see people in your office, consult in the ED
-nice variety (see above)
-you get to wear a mask and a cap (so really it doesn't matter what you look like at work)
-patients need to go through the medical systems sieve to get to you

Things I do not love about the OR/surgery:

-you could seriously eff someone up if you make a mistake (yes that can happen in the ED as well but somehow it seems much worse to botch a cholecystectomy and have a patient end up on the transplant list than to miss an occult fracture in emergency, or fail to intubate a difficult airway...)
-you have to stand still for hours on end and crick yourself into crazy positions to get the job done sometimes
-cautery smoke stinks
-apparently the hours stink too, though the surgeons here have *sweet* hours
-less patient interaction (though that means less of the nasty aspects of patient interaction)
-when you leave work there are still patients in the hospital under your care

The quest continues. Funny thing is my friends/colleagues seem very divided on the matter. I guess it is all part of the great med/surg divide. When I say that I am loving surgery, half the camp starts frothing at the mouth whilst going into a slow-motion dive toward me yelling 'noooooooooooooooo'
and the other half says, 'Yeah! Do it! You've totally got the personality for surgery and would be so good at it.'

Time will tell.

*I have been working in emerg for about 7 years now. Maybe it is the 7 year itch.

Yesterday was my first shift back in the ED after 10 months away. I received a genuinely warm welcome from all of the staff which made the first day seem all buttery and smooth.

I have been chuckling at all the things I have forgotten (how to turn off alarm monitors) and all of the tweaks I am noticing to my practice (ridiculously long patient histories). Also, now I have these urges to perform unnecessary assessments on patients. For example, I suddenly feel the urge to palpate everyone's lymph nodes (and name them off while doing so). I also want to locate apical beats, listen for carotid bruits, and attempt to elicit reflexes.

It had been pleasing to be back in direct patient contact land--for the most part--until I had to be at the other end of a call bell belonging to a *very* curmudgeonly old man who spend most of the afternoon yelling at me and shitting in various locations in the ED. One clogged hopper and sweaty procedure in the patient bathroom later I was ready to throw in the towel on the old nursing gig. The doc I was working with took that moment to remind me of my recent spiel on how I "loved being back at the bedside again". It was well played.

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I had an ICU patient this morning who was an elderly woman, not doing so well post-op. It was decided that she'd be switched to palliative, as her pre-op wishes were DNR. Yesterday she was very fidgety, puling at her ART lines and central lines, so had to be put in restraints. Thus my first order of business today (once the status had changed) was get all those invasive lines out and take off the restraints. She looked so much more comfortable and settled once all the tubes and wires and drains were removed.

I heard later that she'd passed away after being transferred upstairs. It gave me a small moment of thankfulness that I'd been able to make that passage a little more comfortable. Those feelings always make me think "...hmm...palliative care? Maybe."

I do feel accomplishment for both letting patients go peacefully as well as traumatically bringing them back to life.

Tomorrow I am going to be a medical student. I am following one of the surgeons in the OR, his exact words as I left today, "don't worry, we won't let you burn anything important tomorrow". Gotta love the twisted hospital humor. Looking forward to the day. Fingers crossed I won't get the spins and water brash like I usually do when I step under the lights with a mask on.

Tuesday, July 6, 2010

It has been a wonderful whirlwind, travelling from the vibrant Gatineau area to the familiar prairies of Alberta. Too short of a holiday with Tobie and too many people to see out West. I had to compromise for quality not quantity.

Now I am in my new digs in Northern BC. Staring at the ocean from my wood and brick bungalow, decorated with circa 1970's teal couches and ivory appliances.

My luggage, however, is in Nanaimo, BC.

I realized that things were not good when I was waiting for my connecting flight out of Vancouver and noticed my baggage tags were marked with the wrong last name to the wrong destination. The initial flight customer service agent threw out my bag tags and told me there was no record of my luggage in the system and that there was nothing he could do.

Um. No. Unacceptable.

I had to politely ask him to remove my bag tags from the garbage and return them to me. Thankfully a competent agent came to my rescue and actually made phone calls and tacked away on his keyboard for a while.

Apparently the bags are going to arrive this evening, fingers crossed. My first shift back in the ED wearing scrubs and heels would have been interesting.

Currently Reading

"I cannot rest from travel; I will drink Life to the Lees. All times I have enjoyed Greatly, have suffered greatly, both with those That loved me, and alone; on shore, and when Through scudding drifts the rainy Hyades Vext the dim sea. I am become a name; For always roaming with a hungry heart..." Lord Tennyson